Lecture 2 tracheotomy/ tracheostomy Flashcards
1
Q
What is the difference between a tracheotomy, and a tracheostomy?
A
You first do a tracheotomy, which is an emergency procedure that can be temporary & will heal quickly, whereas a tracheostomy is a permanent, long lasting airway in the trachea
- First is a tracheotomy, then possibly made into a tracheostomy
2
Q
What are the characteristics of a tracheotomy?
A
- Opening the trachea at any level/point (not the larynx)
- Opening the trachea to create an airway
- Once decision for tracheotomy, it may then be necessary to determine if a more permanent arrangement has to be made
3
Q
T/F: A tracheotomy is an emergency procedure to open an airway?
A
TRUE
4
Q
What is the criteria for turning a tracheotomy into a tracheostomy?
A
- Pump failure (breathing mechanism, torso, lungs, diaphragm, intercostals)
- Airway blockage (blockage that won’t resolve quickly enough to maintain an airway)
5
Q
What does pump failure mean? and what else does it include?
A
- When the muscles for respiration fail not the lungs tissue itself
- Muscles are nonfunctioning
- Flail Chest: Enough ribs or the sternum was broken
- Injury to brain, brainstem, or spinal cord at the cervical level: Paralysis or paresis
6
Q
What does Airway blockage mean?
A
- In this case if there is blockage the tracheotomy becomes a tracheostomy
- The larynx could be crushed
- There could be stenosis of the larynx → Keeps coming back
- Possibly a broken or swollen larynx
7
Q
Patients who are being evaluated for a tracheostomy may require what?
A
- Either mechanical assistance breathing until the pump (muscle) or lungs can function independently, or maintenance of an airway until the natural airway can be restored.
8
Q
What are the two reasons for tracheostomy?
A
- Pump failure
- Airway blockage
9
Q
What is a ventilator?
A
- Tube to maintain the airway is pushed through the mouth through the VF and into the trachea
- Done through intubation
- More O2 can be ventilated through the lungs → Raise O2 content
- So if lungs aren’t functioning optimally increase the O2 content of the air into the lungs so they can put enough O2 in the bloodstream
10
Q
What are the indicators for tracheostomy?
A
- Length of time on the ventilator
- Difficulty mobilizing secretions
- Airway trauma that won’t resolve quickly
- There can be surgical indications of a tracheostomy being necessary
11
Q
Why does length of time on a ventilator matter when evaluating a tracheostomy?
A
- VF are short and thin, having a tube placed between them for long term is damaging to them, as well as to the ENTIRE VAGUS NERVE COMPLEX in the larynx.
- risks become absolute after a long period of time
- May be edema/swelling right at the VF
- Dental abscesses (caused by intubation)
12
Q
What is the longest time you want someone to be intubated through the larynx?
A
5 - 7 days
13
Q
Why does difficulty mobilizing secretions matter when evaluating a tracheostomy?
A
- Because we are suppose to swallow a couple times per minute, so we need to evaluate how often they are swallowing (will allow s to figure out their mucous secretions)
14
Q
Why are surgical indications of a tracheostomy being necessary when evaluating a tracheostomy?
A
.- Skull or dural surgeries: Tracheostomy may be performed b/c patients who have this have swelling & that swelling results in pressure onto the brainstem which in turn will l effect the breathing
- Head and neck cancers: Indications → Pressures on the brainstem, Cancer is interfering with the larynx Tumor in throat/jaw is closing the airway Laryngectomy
- TBI
15
Q
How do you manage secretions?
A
- Suction!
16
Q
What is suction?
A
The removal of secretions from the airway
17
Q
T/F: Suction is a sterile technique?
A
FALSE, it is a clean technique
18
Q
What must we always do when working with tracheotomy/tracheostomy clients?
A
WASH OUR HANDS
19
Q
What must we do if a patient is distressed while we are suctioning?
A
Review our technique, there should be no pain during this procedure
20
Q
What things do we check for when evaluating secretions?
A
- How does it look?
- Thickness
- Smell
- Is there blood?
21
Q
What are the two most important rules?
A
- WASH YOUR HANDS
- CHART EVERYTHING YOU DID
22
Q
What equipment do we need for suctioning?
A
- Suction unit;
- Suction catheters;
- Suction unit connecting tubes;
- Bowl or bottle of tap water to flush the suctioning tube (tap water ok)
23
Q
Steps for suctioning –
A
- It is a good idea to have a new suction catheter (in its packet) attached to the tubing from the suction pump, in case you need to suction in a hurry, and to ensure that the pump is ready to be used at all times.
- Wash or gel your hands. (If suction is required in a hurry this may be impractical). → wash your
- Turn on the pump and check the pressure as instructed.
- Gently insert the catheter into the tracheostomy tube (with your thumb off the side port of the suction catheter). The distance it is passed depends on the length of the tracheostomy tube – this will be explained to you while you are in hospital.
- Apply suction, by covering the port with your thumb, and slowly withdraw the catheter.
- Do not rotate or twirl the catheter as you remove it.
- Repeat if the patient still needs suction. Give your patient time to catch a breath between suctions.
- Disconnect the catheter from the tubing and dispose of it safely. Clear the tubing by suctioning a small amount of water through it. Discuss waste disposal with the ward staff as different arrangements may need to be made when you are at home. Attach a new catheter ready for next time.
24
Q
What are the different types of speaking valves?
A
- One-way
- Two-way
25
What is a one-way valve?
- One way valve (inhale but exhale goes out the normal way (through trachea, larynx, mouth & nose)
- Opens when the patient breaths in and closes when they exhale
- Inhale but exhale through VF up to the nose and mouth
- Can be placed at the end of the tracheostomy tube
26
What is an issue with a speaking valve?
- If there is a big trach tube in there and the patient can’t talk, it isn’t because the VF aren’t working it is because they can’t get the air to the level of the VF.
- The tracheostomy tube is big and fills the trachea, the patient will not be able to get air around it = no speech
27
What is a two-way valve?
Where you inhale and exhale through the valve
28
When assessing for a speaking valve, what does an SLP look for?
- patient’s suitability for a speaking valve. This is determined by the patient’s ability to tolerate a speaking valve.
- Tolerance is judged by the patient’s ability to maintain reasonable oxygen saturation levels in the blood.
- Oxygenation: the level of O2 in the level of the body – specifically blood
29
What do oxygen sats (saturated levels) measure?
the percentage of hemoglobin binding sites in the bloodstream that are occupied by oxygen
30
T/F: If the patient can’t tolerate a speaking valve, he or she may still be able to achieve a voice because of air leaking around the tube.
True
31
What are the types of tracheostomy tubes?
- Single cannula, cuffed.
- Double cannula, cuffed
- Metal cannula, non-ciffed
- Single cannula, non-cuffed
- Fenestrated, cuffed
32
What is a Single cannula, cuffed and what does it contain?
- Cuff may be permanent
- These need to be tied; they can cough these up
What does it contain?
- Obturator
- Connector
- Inflation line
- Side-port connector
- Fome-Cuff
- Tube Ties
- Flange
33
What does a Double cannula, cuffed contain?
- Neck plate
- Obturator → “Insertion help” AKA “Introducer”
- Cannula
- Foam cuff
- Inner cannula
- Connector
- Side port
34
How can the metal cannula, non-cuffed be cleaned?
It can be scrubbed, boiled, and left to soak in hydrogen peroxide
35
T/F: Metal cannula, non-cuffed is a tube someone can have for only a short period of time?
False, they can have it for a long period of time
36
T/F: in a single cannula, non-cuffed you can see the flanges to tie the shoe string onto?
True
37
What is a fenestrated cuff?
* She spent a lot of time on this one*
- Fenestra = latin for “window”
| - Idea is that it imitates normal function WITHOUT the tube
38
What may a fenestrated cuff consist of?
- a single cannula,
- and inner and outer canula,
- there may be a cuff, may not be a cuff
- but it will also have an obturator/introducer
39
T/F: Potentially you could use a fenestrated tube as a speaking valve?
True
1. Take out the inner cannula,
2. Plug the tube
3. & this could potentially becomes a speech valve
40
What are the benefits of the fenestrated tube?
- Opening of outer cannula
- So air through the lungs can pass through the VF, into the mouth and nose → so potentially you can use this for normal breathing
41
What is the final step before decannulation?
Fenestrated tube
42
What is a bronchoscopy?
An examination of the inside of the trachea and of the large air passages leading to the lungs.
Usually done as a way of assessing the degree of narrowing of the trachea and the overall general condition of the trachea and the air passageways.
43
What are you looking for in a bronchoscopy?
- Is there trachea stenosis?
- Is there bronchi stenosis?
- Is the airway getting narrower?
44
Review the Flow Chart for Assessing Voicing Ability
.
45
When dealing with swallowing issues, what needs to be centered in the airway and why?
Cannula
Because It lessens the risk of aspiration and it helps to keep the tube from rubbing the airway, which can lead to tracheal deterioration.
46
What must we do before any of our patients decide to eat?
SUCTION!; no matter their age!
47
When we have babies on our caseload what must we never do?!?!
- Leave them alone while eating, even if they are eating good!
48
What is tracheal deterioration?
walls of trachea begin to dissolve
49
What is the name of the process of removing the tracheotomy tube?
Decannulation
50
What is the process of decannulation
- Placement of a smaller trach. Tube; stoma gradually closes around the tube –once the smallest trach tube is placed they will plug the stoma and see if you can breathe without it.
- Place an airtight dressing (saran wrap) on the stoma to confirm you can breathe
- Once they decannulate they will keep patient for 1 – 2 days for observation
- Stoma will usually close up on it’s own in time
- Make sure patient is strong enough to function without it
- They want to watch you over a number of days before they send you home
